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FINAL REPORT OF THE

LEGISLATIVE COMMISSION ON MEDICAL

COST CONTAINMENT

NORTH CAROLINA GENERAL ASSEMBLY

LEGISLATIVE SERVICES OFFICE

2129 STATE LEGISLATIVE BUILDING

RALEIGH 2761 1

RGE R HALL. JR

5LATIVE Administrative Officer

PMONt 7337044

GERRY F COHEN DIRECTOR

Legislative drafting Division

Telephone 733-6660

thomas l covington. director

Fiscal Research Division
Telephone 733-4910

m. glenn newkirk. director

Legislative Automated Systems Division

Telephone; 733-6834

TERRENCE D SULLIVAN. DIRECTOR

Research Division

telephone: 733-2578

July 17, 1985

The Honorable Robert B. Jordan, in
North. Carolina General Assembly
Legislative Office Building
Raleigh, North Carolina 27611

Dear Lieutenant Governor Jordan:

The Legislative Commission on Medical Cost Containment was
established by the General Assembly in 1983, and with thi<5
report we are completing our work.

Over the past 18 months the members of the Commission have
heard from many North Carolina citizens on the problems of
medical cost containment. While none of our members believe
that the rapid rise in medical costs will be totally solved by
the recommendations of this Comm.ission, we do believe that they
will contribute to the foundation that has already been laid by
the work of previous legislative sessions.

We stand ready to answer any questions that members of the
General Assembly may have about our report.

Sincerely,

W. Craig Lawing
James D. Black

LEGISLATIVE COMMISSION ON MF.OICAI. rO.^T QON'I'A] NMKN'

MEMBERSHIP

Representative James B. Black - House Cochairman
Senator W. Craig Lawing - Senate Cochairman

Mr. Carson Bain

Mrs. Jimmie Butts

Mr. William Eller

Mrs. Helen Goldstein

Representative Barney Woodard

Senator Anthony Rand

Dr. Sandra Greene

Mr. Travis Tomlinson, Sr.

Mr. Jack Willis

Dr. Lawrence Cutchins

Mr. Robert F. Burgin (Ex Officio)

TAIM.K OV (.'ONTKNTS

Suminary of the Coitmission ' s Activities 1

Recommendations to the 1984 General Assembly 3

Summary of 1984-85 Commission Activities 7

Recommendations to the 1985 General Assembly 8

Appendix A - List of Persons Appearing

Before the Commission 13

Appendix B - Ad Hoc Hospital Data Committee Membership .. 17
Appendix C - Report of the Hospital Data Committee 19

Appendix D - Preliminary Report on Indigent Care in North
Carolina

Appendix E - Health Education and Preventive Health Care
Subcommittee Membership

Appendix F - Report of the Health Education and Preventive
Health Subcommittee

Appendix G - Health Planning and Certificate of Need
Subcommittee Membership

SUMMARY OF COMMISSION ACTIVITIES

The 1983 session of the General Assembly enacted Senate
Bill 518, "An Act To Create The Legislative Commission On
Medical Cost Containment". The legislation authorized the
Commission to study the following issues:

1. The present health care system in North Carolina and
the cost trends associated with that system;

2. The cost trends resulting from the problem of the
collection of hospital bad debts;

3. The North Carolina Medicaid program and the cost
trends associated with that program;

4. The medical cost containment programs established in
North Carolina and other states;

5. The composition^ funding structure, staffing hearing
procedures, public comment procedures and other
aspects of the operation of the Health Systems
Agencies;

6. The operation of hospital rate review programs;

7. The experience with North Carolina's certificate of
need law.

The Commission's meetings were heavily attended by members
of the public and representatives of all major provider groups
and professional associations. Over 50 persons spoke to the
Commission on various topics, and some speakers appeared on
several occasions. A partial list of presenters is contained
in Appendix A of this report.

The work of the Commission can be divided into two phases.
Phase 1 began in December 1983 and continued through March
1984.

Phase I activities consisted of the following:

° An overview of the medical care delivery system in

the United States and North Carolina and those
factors that contribute to the cost of health care.

° The impact of governmental and private sector reim-
bursement practices on the cost of health care.

° Utilization patterns in North Carolina hospitals,

with particular emphasis on the small rural hospital.

° The financial condi ti on of North Carolina liospitals.

" Defensive niedicine and itr. role in increasing hfalthi
care costs.

° Nursing lioiiie bed moratorium.

° North Carolina's Medicaid program.

" The implementation of Diagnostic Related Groupings

(DRG's) in the Medicare program.

" The role of various medical professionals in holding

down the cost of care.

** The operation of health planning, certificate of
need, and health systems agencies (HSAs) in North
Carolina .

*• The need for hospital utilization and cost data by
government, business, and industry.

° Indigent care in North Carolina and cost shifting to

private patients to pay for that care.

" Certificate of need and insurance law changes relat-
ing to alcohol and drug rehabilitation program.

° Proposal to finance indigent care in North Carolina
through a lottery.

After reviewing these topics, the Commission determined
that the focus for the 1984 legislative session would be
matters that required immediate action by the General Assembly.

Tc expedite its v/ork the Commission appointed a subcommit-
tee to deal with issues relating to health planning and certif-
icate of need laws. This subcomjnittee, chaired by Mr. Carson
Pain was very active in 1984 and continued its work in 1985 for
the final report tc the General Assembly.

RECOMMENDATIONS TO THE 1984 SESSION
OF THE GENERAL ASSEMBLY

HB 1613 AN ACT TO PROVIDE TIME TO STUDY THE NEED FOR AND THE
SB 741 PROVIDING OF SERVICES BY HOME HEALTH AGENCIES AS
ALTERNATIVE TO INSTITUTIONAL CARE

Findings

Home Health Services are defined in state regulations as a
range of services rendered to patients in their homes by a home
health agency. Home health agencies must provide skilled
nursing care and at least one other therapeutic service to
persons in their homes. These other services may include home
health aides services; physical therapy; occupational therapy;
speech therapy and audiology services; or services of a medical
social worker.

Currently there are 96 certified home health agencies in
North Carolina.

Recently there has been a trend toward the growth of new
home health agencies, but it is not clear whether new programs
are needed or expansion of existing agencies.

Recommendations

The findings of the Commission included 1) a concern about
the rapid growth of new home health agencies 2) a concern
about excess costs as a result a duplication of services 3)
need to assess the impact of these changes in home health
service.

This moratorium was recommended by Dr. Sarah Morrow,
Secretary of the Department of Human Resources.

HB 1585 AN ACT TO END THE MORATORIUM ON NURSING HOME
SB 744 CONSTRUCTION

Findings

In the fall of 1981 the General Assembly placed a mora-
torium on the construction of new nursing home beds for the
following reasons: 1) additional time was needed to develop
community alternatives to institutional care; 2) additional
time was needed to assess the impact of the Reagan budget cuts
on the state's Medicaid program; 3) to force the construction
of nursing home beds for which certificate of need had been
awarded but no active construction had begun. There were in
excess of 1,000 beds in this last category. The language
establishing the moratorium said that until all beds for which
certificates of need had been awarded were constructed and
occupied at 75%, no new certificates of need would be issued.

The LegislativG Commission on Medical Cost Containment wns
informed by the Department of Human Resources that all beds for
which certificates of need had been awarded prior to the freeze
had been built and were at 75% occupancy, with one exception.
This exception was a skilled nursing unit attached to Pender
Memorial Hospital in Burgaw. Based on estimates furnished to
the Department of Human Resources by the architect it is not
likely that the project will be completed and at 75% occupancy
prior to the end of 1984.

Recommendation

The Commission felt that in view of the need for addition-
al nursing home beds in North Carolina; the time needed to
review and award certificates of need; and the lag time in
building new facilities; that it would be best course of action
for the General Assembly to lift the moratorium effective July
1, 1984.

HB 1612 AN ACT TO EXTEND THE FREEZE ON THE ISSUANCE OF
SB 740 CERTIFICATE OF NEED FOR NEW INTERMEDIATE CARE
FACILITY BEDS FOR THE MENTALLY RETARDED

Findings

The 1983 Session of the General Assembly enacted HB 583
establishing a one-year moratorium on the awarding of certifi-
cates of need for intermediate care facilities for the mentally
retarded (ICF/MR) . The current freeze expires June 30, 1984.
ICF/MR beds are a specialized category of nursing home facility
in which treatment, education, and rehabilitation services are
provided to retarded persons. The reason for this freeze was
to give the state, local governments, and the patient advocate
groups more time to plan for the residential needs of retarded
persons .

Dr. Sarah Morrow, Secretary of the Department of Human
Resources, came before the Medical Cost Containment Commission
and asked that the moratorium be extended for six months, until
January 1, 1985.

Recommendation

The Commission believes that extending the freeze for six
months would allow for more public input and planning on the
need for additional ICF/MR beds.

HB 1586 AN ACT TO MAKF FINAL AC;EKCV PFC 1 .^
SB 74 2 CERTIFICATE OF NEED APPELABl.E TO
CAROLINA COURT OF APPEALS

I (IN? CN
THE NORTH

Findings

Under current North Carolina law the final decision by the
Department of Human Resources to award a certificate of need
may be appealed to Superior Court, and from there to the Court
of Appeals, and the North Carolina Supreme Court. There is no
federal requirement that cases go to all three levels of the
North Carolina court system.

The Commission found that because of the extremely compet-
itive nature of the certificate of need process many of the
final decisions by the department were being appealed to the
courts. If a plaintiff chose to exercise all rights of appeal
a decision on vitally needed services might be prolonged for
many years.

Because of the extreme complexity of these cases and the
very lengthy records that are usually involved, they place a
great burden on the Superior Court .

Recommendation

Following a final agency decision, an appeal of any
certificate of need case should go directly to the North
Carolina Court of Appeals.

SB 744 TECHNICAL AMENDMENTS TO THE CERTIFICATE OF NEED LAW

Findings

The Commission found that a number of technical changes
were needed in the certificate of need law to better align
regulatory practices with existing laws.

Recommenda t i on

The Commission submitted all of these technical changes as
one om>nibus bill to the 1984 session of the General Assembly.

Senate Rill 775

AN ACT TO INCREASE THE LIIVIT ON MAJOR
MEDICAL EQUIPMENT REQUIRING A CERTIFICATE
OF NEED AND MAKE IT APPLICABLE TO
PHYSICIANS IN ADDITION TO HEALTH CARE
FACILITIES

Fir dings

The current law requires a certificate of need if a
hospital or other institution acquires a piece of medical
equipment. Major medical equipment in physicians' offices is
now covered only if the equipment v/ill be used to serve in
patients of hospitals.

During its deliberations the Commission reviewed in detail
the current Certificate of Need Law. The consensus was that
hospitals and physicians should be treated equally.

Under the current law the local health system agencies and
the State may decide that there is a need for only one CAT
scanner or Nuclear Magnetic Resonance machines in a given area.
Decisions on need art- based on the most efficient use of
equipment, and getting the most cut of dollars expended.
Nothing in current law, however, would prevent private groups
of physicians from purchasing the same equipment and seeing
patients on an outpatient basis.

The results of these purchases by private groups would
likely be the following 1) greater overall expenditures for
medical care within the county 2) possibly underutilized
equipment in both hospitals and physicians' offices because of
excess capacity.

RecomjTiendation

The Commission recomjr.ended to the ]984 General Assembly
that major medical equipment be covered under the certificate
of need law in both hospitals and outpatient settings.

FUNDING FOR HEALTH SYSTEM AGENCIES .(HSAj^

The Commission recommended that the General Assembly
tc>ntrihute State funds to the Health System Agencies. This
item v,-a£ funded in the main appropriations bill.

In the section of this report dealing with recommendations
to the 1985 General Assemibly, the Comm.ission has spoken further
to this issue.

ACTIONS _B_Y_ THE 1984 GENERAL ASSEMBLY

All of the recoirjiiendations to the 1984 General Assembly
were enacted with the exception of the expansion of the certif-
icate of need law to cover major medical equipment in an
outpatient set/ling.

SUMMARY OF 1984-85
COMMISSION ON ACTIVITIES

The Commission activities in the 1984-85 period were
focused in three areas: 1) the collection of medical data 2)
indigent care 3) health education and preventive health care.
The Commission co-chairmen appointed Mr. Robert Burgin, Presi-
dent of Memorial Mission Hospital, as an Ad Hoc member of the
Commission. Mr. Burgin had just completed work with a special
task force in Buncombe County that had studied the problems of
indigent care.

MEDICAL DATA

After hearing about the need for uniform hospital data for
purchasers of health services, health care providers, state
agencies, and insurers the co-chairmen appointed a special Ad
Hoc Committee to review this issue. This Committee was
composed of commission members, representatives from business
and industry, the North Carolina Hospital Association and the
North Carolina Medical Society. Appendix B contains a list
of the members of this committee. This committee met for
several months and a copy of its report and recommendation is
contained in Appendix C.

UNCOMPENSATED CARE

In the past two years nationwide attention has been
focused on the growing problem of uncompensated indigent care,
especially in hospitals. The Commission spent a number of
meetings hearing testimony on the extent of this problem in
North Carolina. A major study conducted by the Center for
Health Policy Research and Education is now underway in North
Carolina, and the preliminary results were presented to the
Commission in January 1985. A copy of this report is contained
in Appendix D.

HEALTH EDUCATION AND PREVENTIVE HEALTH CARE

In recent years attention has been focused in both busi-
ness and government on the effectiveness of preventive health
programs. A subcommittee of the Commission dealt with these
issues, particularly with regard to health education programs
in the public schools. A copy of this subcommittee's report
and a membership list is contained in Appendix E and F.

RECOMMENDATIONS TO THE 19 85 GENERAL ASSEMBLY

MFDICAL DATA AND HCPFTTAL RATK KLIVIKW

1. Hospital rate review agencies now operate in a number of
states, and they appear to contribute to a reduction in
the rate of increase in hospital costs in these states.

2. The Commission also found that for a hospital rate review
program to be successful it must cover all payors,
governmental and private alike. At this time, however, it
appears that the federal government may not allow
additional waivers for a state to assume responsibility
for Medicare rates .

3. During its review the Commission found that the growth of
alternative health delivery plans in North Carolina
accelerated within the past 24 months. The full impact of
alternatives such as health maintenance organizations,
preferred provider plans, and preadmission certification
programs on hospital admissions and costs may not be felt
for another 12 to 18 months.

4. The Commission also found that both the public and private
sector have a great need for timely and accurate
information on the cost and utilization of health care
cervices. The greatest need for this kind of information
is in the area of hospital utilization. Research
presented to the Commission shows wide variations in rates
of hospitalization for the same procedures in North
Carolina communities. These variations in patterns care
have contributed to the rapid increase in the cost of
health care.

Recommendations

The Commission recommends that the General Assembly
establish a system to monitor the cost of health care costs in
North Carolina with particular emphasis on hospitals, but that
no action should be taken at this time to create a hospital
rate review authority in North Carolina.

As an alternative to rate review, the Commission
recommends the creation of a statewide medical database to be
made available to all purchasers of health services, health
care providers, state agencies, and insurers on the cost and
utilization of medical services in North Carolina. The
database would begin with a record of each acute inpatient
hospital admission in North Carolina, and could be expanded to
other services in the future with approval of the General
Assembly. A copy of the recommended bill is found in Appendix
C.

Careful monitoring of hospital costs and utilization
should occur, and if costs were again to accelerate at a rapid
rate consideration should be given to alternatives, such as
hospital rate review, to restrain these increases.

STATE TECHNICAL ASSISTANCE TO HOSPITALS

Findings

Major changes are occurring in the hospital industry during the
1980's as a result of:

° Changing medical referral patterns within communities.

° Governmental initiatives that affect Medicare and Medicaid

reimbursements. e.g. Medicare payments based on Diagnos-
tic Related Grouping (DRG's) and reductions in federal
Medicaid appropriations.

" Declining inpatient utilization due to stronger uti-
lization controls in the public and private sector.

" The cost of providing services to indigent patients.

The impact of these changes are being especially felt in
public hospitals of less than 200 beds. Because of these
changes in patterns of care and reimbursement county
governments are becoming increasingly involved in the problems
of local hospitals.

Both hospitals and commissioners in recent months have
found the need to request assistance from the State, but no
single agency within the executive branch has been designated
to coordinate these requests.

Recommendation

The Commission recommends that the Governor designate an
existing agency within the Department of Human Resources to
provide technical assistance on hospital matters to county
governments or hospitals when such assistance is requested by
the hospital trustees or the county commissioners.

Since the subcommitte on Health Planning made its initial
recommendation on this issue. Governor Martin has designated
the Office of Rural Health Services of the Department of Human
Resources as the lead agency for the Community Hospital
Technical Assistance Program. Assistance under this program
will be provided to county-owned or private non-profit
hospitals that request assistance from the state.

HEALTH SYSTEM AGENCIES FINDING

The Commisrion finds that there; is a need for a strong
local role in the health planning and certificate of need
process. Health system agencies provide a way for both
consumers and providers to come together to help determine
local health care needs. Without this advice the state would
be in the difficult position of attempting to make all health
planning decisions from Raleigh.

Recommendation

The Commission recommends that the state retain the
present Health System Agency System, and that these local
agencies continue in an advisory role on health planning and
certificate of need matters.

The Commission also recommends, as it did in 1983, that
the General Assembly continue to appropriate $360,000 in each
year of the 1985-87 biennium as a grant to these agencies.

HEALTH EDUCATION AND PREVENTIVE HEALTH CARE

Findings

House bill 540, entitled "An Act To Establish A Statewide
School Health Education Program Over A Ten-Year Period," was
enacted by the General Assembly in 1978. The Act (G.S.
115C-81 (e) , a copy of which is attached, authorized the
appropriation of funds for employing health education
coordinators, with the goal of one coordinator per local
education agency. Additionally, the Act called for one
additional consultant's position in Department for Health
Education; and the creation of a statewide health education
advisory council to "provide citizens input...." The
legislation also called for the development of a health
curriculum for grades K-9. In 1979, the General Assembly
passed HB 974 which allocated funds for eight (8) additional
health education coordinators. In 1984, funds were
appropriated for the employment of 16 additional health
coordinators .

HB 276 introduced in the 1985 Legislative Session calls for
funding of 32 additional positions.

Recominendat ions

1. The Commission recommends that the General Assembly
continue the expansion of the health education coordinator
program as originally proposed in HB 540. This would
continue to expand the program until there was a health
education coordinator in all school districts.

2. The commission recommends that the health education
coordinator program be a part of the proposed Basic
Education Plan (HEP) .

GENERAL ASSEMBLY - MEDICAL COST CONTAINMENT

Findings

The General Assembly has established two Commissions on
Medical Cost Containment since 1977. Both of these have made
numerous recommendations to the General Assembly, but the lack
of an ongoing effort in the medical cost containment area makes
it difficult for the General Assembly to formulate policies
that may need to be enacted over several bienniums.

Recommendations

The Commission recommends that the General Assembly
establish a standing Commission similar to those that now exist
in the mental health and special education fields to work on
matters dealing with medical cost containment, and other issues
that the General Assembly may see fit to assign. Such issues
might include the promotion of cost containment in the state
employees health insurance plan.

INDIGENT CARE AND MEDICAID USE OF DIAGNOSTIC RELATED GROUPINGS

Findings

The Commission heard testimony from hosptials, physicians,
and the business community about the problems of indigent care
and the cost shifting that must occur to pay for that care. As
a part of this review the Commission examined the Diagnostic
Related Grouping (DRG) reimbursement system as it is now being
implemented in the Medicare program. The Commission found that
while the new payment system is helping to reduce lengths of
stay in hospitals, it still appears too early to assess the
impact on the hospital system in North Carolina. Thus it
appears premature to adopt such as payment system in the
Medicaid program.

A major study is now underway in Nortli Cniolina, by t.he
Center for Health Policy Research and Education at Duke
University, that examines the health care costs of both the
uninsured and the underinsured in North Carolina. The report
will also examine the options that are available to government
and business for dealing with the problem. The results of this
study are not yet available, and the Commission is not prepared
at this time to make recommendations on legislative actions on
uncompensated care.

Recommendations

Indigent Care

The General Assembly should continue to study the issue of
indigent care and the options that are available to address the
problem. Such a study might be best handled by a special study
commission devoted solely to this task.

Use of Diagnostic Related Groupings for Medicaid Reimbursement

The Commission recommends that further study occur by both
the Department of Human Resoruces and the General Assembly
before a decision is made to implement a DRG Type of program in
the North Carolina's Medicaid program.

APPENDIX A - LIST OF PERSONS APPEARING
BEFORE THE COMMISSION

PERSONS APPEARING BEFORE THE COMMISSION

Ms. Barbara Matula

Director, Division of Medical
Assistance, Department of Human
Resources

Mr. Ernest Messer

Mr. Glenn Wilson

Director, Division of Aging,
Department of Human Resources

Chairman of the Department of
Social and Administrative
Medicine, UNC School of
Medicine

Dr. Deborah Freund

Dr. Jack Hughes

Mr. Pete Roy

Mr. Dan Mosca

Professor Health Policy
Administration, UNC Chapel Hill

President (1983) N. C.
Medical Society

Director, Management Services
N. C. Hospital Association

President (1983) N. C. Health
Care Facilities Association

Mr. James Bernstein

Director, Office of Rural Health
Services

Mr. Calvin Michaels

Mr. Jan Rivenbark

Mr. Charles N. Burger

Mr. William D. Fullerton

Dr. Stuart Fountain

Ms. Judith Seamon

Director of Personnel, Burlington
Industries, Inc.

Director, of Compensation and
Benefits, Hanes Group

Director, Uniform
Business/Medical Coalition,
Hickory, N. C.

Adjunct Professor, Department
of Social and Administrative
Medicine, UNC - Chapel Hill

Member of the Board of Trustees
of the N. C. Dental Society

President, N. C. Nurses
Association

Ms. Linda Cothrell

President, N. C. Nurses
Association of Nurse Anesthetists

Dr. r. uncan Yaggy

Lr. Barbara Krair,er

Mr. Gary Vaughan

yr . George Stockbridge

Senator Marvin V.'ard
Dr. Sarah Morrow

Mr. Bill Shenton
Dr. William Weissert

Mr. Noah Huffstetler
Mr. Jack Pleasant

Mr. Charles Moeller

Dr. Edward McKensensie
Mr. Bob Burgin

Mr, Kenry Nurkin

Mr. Bryon L. Bullard

Mr. George Stiles

Dr. Robert Payne

Mr. Ken Brown

Mr. Melvin Whitley

Chief Planning Officer,

Duke University Medical Center

Director State Health Planning,
Department of Human Resources

Director, Certificate of Need,
Department of Human Resources

Executive Director Capital Health
Systems Agency

Winston-Salem, N. C.

Secretary, Department of Kum>an
Resources

Attorney at Lav/

Professor of Health Policy and
Administration, UNC - Chapel Hill

Attorney at Law

N. C. Legal Services
Resources Center

Director, Western Health
Systems Agency

Salisbury, N. C.

President, Memorial Mission
Hospital, Asheville

President, Charlotte Memorial
Hospital and Medical Center

President, Charlotte
Presbyterian Hospital

Executive Director,
Mecklenburg County Health Care
Cost Management Council

President, Mecklenburg
County Medical Society

Preferred Care of K. C.

Carolina Action

Mr. r£.ncly Desonia

Ms. Inez Myles

Dr. Regionald Carter

Ms. Janet Campbell

Dr. Patricia Danzon

Mr. Steve Morrisette

Mr. Ron Aycock

Ms. Donna Montgomery

Interyovcrnmentci.l IlcaJtb. Ptvlic-y
Project - George Washington
University Mecklenburg Council
of Senior Citizens

N. C. Senior Citizens Federation

Duke University

N. C. Hospital Association

N. C. County Commissioners
Association

N. C. Alliance for Social
Security Disability
Recipients

APPENDIX B - AD HOC COMMITTEE ON HOSPITAL

DATA

AD HOC COMMITTEE ON HOSPITAL DATA

Dr. Sandra Greene - Chairman

Mr. Pete Burger

Dr. John Foust

Mr. Eugene Hill

Mr. Calvin Michaels
Senator Tony Rand

Mr. Travis Shamel

Mr. Jack Willis

Mr. Glenn Wilson

Dr. Duncan Yaggy

APPENDIX C - REPORT OF THE HOSPITAL DATA COMMITTEE

UI^/^J^

Attachment 1

PROPOSAL FOR A STATEWIDK MEDICAL DATABASF.
November 19, 198A

Purpose

The purpose of a statewide medical database is to make available to pur-
chasers of health services, health care providers. State agencies, and
insurers, information on the cost and utilization of medical services in North
Carolina.

Scope

Initially, the database is to contain a record of each acute inpatient
hospital admission in North Carolina. This would include admissions to non-
federal acute care hospitals for all payors: Medicare, Medicaid, Blue Cross
and Blue Shield of North Carolina (BCBSNC), commercial insurance companies,
self-pay and nonpay. At a later stage of development, other categories of
service may be added: emergency room use, long-term care episodes, nursing home
care, etc.

The database will be continually updated on a quarterly or semiannual
basis. The data will be based on dates of services such that a database for
1985 would consist of records for all patients discharged during 1985.

Governance

A permanent nine nember ;o7nmission will be established to direct the

Statewide Medical Database. The composition would be:

3 Employers (one with 500+ employees, one with 100 - 500 em-
ployees and one with less than 100 employees, to be chosen
after consultation with the North Carolina Citizens for
Business and Industry and other employers)

1 Hospital administrator, as recommended by the North Carolina
Hospital Association

e«r»ii^nd**b)rYhe*Norfti Carolina Medic

1 Physician, as rerf*wwhd«*!fcb)rtheTJortn Carolina Medical Society

1 Representative of State government at large

1 Commercial insurance company representative from a company
licensed and active in the health Insurance industry in
North Carolina

1 Blue Cross and Blue Shield of North Carolina representative

Chairman, Board of Trustees, Teachers and State Employees
Comprehensive Major Medical Plan

North Carolina Insurance Commissioner, ex officio and non-
voting

Secretary, North Carolina Department of Human Resources, ex
officio and nonvoting

The employer from a business with 500 or more employees, the hospital ad-
ministrator and the representative of a commerical insurance company will be
appointed by the General Assembly upon the recommendation of the Speaker of the
House of Representatives. The employer from a business with 100 to 500 employees,
the physician representative and the BCBSNC representative shall be appointed by
the President pro tem of the Senate. The employer from a business with less
than 100 employees, the representative of State government at large and the Chair-
man of the Board of Trustees of the Teachers and State Employees Comprehensive
Major Medical Plan shall be appointed by the Governor.

The Chairman will be one of the nine members, as elected by the members.
Commission members will serve staggered three-year terms with three expiring
each year. An individual nay serve a maximum of two full terms.

Agency to House the Commission

The agency designated to house the Conmission for housekeeping purposes
is the North Carolina Department of Administration.

Data Processor

The Commission will contract with a data processor to carry out the pro-
ject.

DRAFT

The function of the data processor is to collect the data from hospitals
and third party carriers, to build and maintain the databases, and to analyze
the information. This will be done under the governance of the Commission.
The data processor will maintain a staff to develop annual utilization and
cost reports. The staff will also be available to analyze more specific in-
formation at the request of an employer, an HSA, a State agency, or other
interested party. Guidelines for reports and special requests would be developed
by the Commission. :

Process

The data are to be obtained as a byproduct of the UB-82 claim form.* It
Is the responsibility of the Commission to determine the most cost effective
method of obtaining the data. Initially, it is likely that this will necessi-
tate some data submission by insurance carriers, as well as some submission
from the hospitals. For the four largest groups of insured in North Carolina
(BCBSNC subscribers. Medicare, Medicaid and State employees), the carriers will
provide tapes of the UB-82 claim forms. For patients not included in one of the
above four groups, the Commission will decide on an annual basis the appropriate
method of collection. The primary method would be to obtain a copy of the claim
from the hospital either on paper or tape. However, for carriers that account
for substantial numbers of hospital discharges, the Commission may later request
that the North Carolina Insurance Department require a tape of those discharges
from the carrier. A determination of which carriers would be affected would
be made prior to each new year of data collection. Then hospitals and carriers

*UB-82 is the new uniform hospital billing form used in North Carolina by all
providers since October 1, 1984.

DRAFT

would be notified by the North Carolina Department of Insurance. The State
will mandate the provision of this information from the hospitals and car-
riers to the Commission.

Data Elements

The UB-82 claim form contains more information than is needed for this
project. Therefore, only selected data elements would be extracted.

There are 28 data elements to be included for each hospital discharge,
comprising about 200 characters (see attached list). These data elements
include information on the patient, the hospital, the physicians providing
care during the admission, the nature of the admission, surgical procedures
performed, and charge information by ancillary category.

Confidentiality

To insure confidentiality of individual patient records, patient names
are to be omitted from the database.

Guidelines on the accessibility and dissemination of the data will be
developed by the Commission.

Cost

A preliminary estimate indicates that the annual cost of a statewide

hospital data base is about $400,000 - $450,000. This includes funds for the

following activities:

Qualified staff to oversee the development and maintenance of
the database.

Reimbursing carriers that supply tapes of the UB-82 claims.

Reimbursing hospitals for the expense of providing the data to the
data processor.

Data entry forlihe ^ iKiHftinr ■! i ^ ^^4,^,. „ tmrnti ^ , .

form fro^the |^.ff ^' iT^B.'^^- s««tWltte.l ,. ^,p«,

° database'"^^"^ ^°' building, updating and maintaining the
° tZ'Jata'.'"' ''^''^^^"^^"S ^" ^""-1 "port of cost and utiliza-
" Technical staff available to respond to specific requests for
Board members' travel expenses.

$IoroOo'"s450 llr/^l' T 'r' "''' '^ substantially less than the
;.^UU.UUU $450,000. due to the time involved in start up.)

Funding

The Commission will be funded initially with 100 percent State funds.
Subsequently, partial support will be sought through corporate grants, founda-

cion grants and user fees.

H.E.R.

DE HOSPITAL DATABASE

-1. Patient control number

2. Date of birth

3. Sex

4. Zip code of patient's residence

5. Eaployer name

• 6. Hospital identifier (Federal tax number)

7. Payer identification

S. Source of admission

9. Admission date

10. Discharge date (statement covers period)

11. Patient status

12. Principal diat?nosis

13. Other diagnoses (4)

14. Principal procedure

15. Other procedures (2)

16. Attending physician ID

17. nther physician ID
13. Total hospital charge

19. Room and board charges

20. Operating room charge

21. .Anesthesia charge

22. Phamacy charge

23. Radiology charge

24. Laboratory charge

-5. 'ledical surgical supplies i devices charge

26. Physical therapy charge

27. Respiratory services charge

28. Incremental nursing charge

No. of UB-82

Characters

Manual Page

130

105

134

135

133

139

144

145

72-77

82-83

197

APPENDIX D - PRELIMINARY REPORT ON INDIGENT CARE IN

NORTH CAROLINA

Presentation to the

Legislative Commission on
Medical Cost Containment

Duke University
Center for Health Policy
Research & Education

NOTE: All figures contained in this briefing arm praliininary
^^^^jnates and should not be disseminated further %d.thout
permission fron the Center for Health Policy Research and

Education.

ESTIMATED NUMBER Oh PERSONS
WITHOUT PUBLIC OR PRIVATE HEALTH INSURANCE
NORTH CAROLINA, 1984

INCOME
LEVEL

TOTAL
1984

POPULATION

774,742

AVERAGE DAILY

UNINSURED

PERSONS

Rate

Total
Persons

Distri-
bution

ALWAYS
UNINSURED

Very Poor

18.1%

140,057

19 %

95,945

Poor

409,609

16.5

67,743

46,170

Near Poor

954,863

17.7

168,766

115,665

All

Others

4,059,099

8.7

351,192

265,630

TOTAL

6,198,313

11.7%

727.758

100%

523,310

es: 1976 Survey of Income and Education (North Carolina data)
1977 National Medical Care Expenditure Survey.

1981 North Carolina Citizens Survey (Fall).

1982 North Carolina Citizens Survey (Fall).

1983 Colorado Health Survey.

ESTIMATED DISTRIBUTION OF

AVERAGE DAILY UNINSURED PERSONS IN

NORTH CAROLINA, 1984

AVERAGE

AGE

DAILY
UNINSURED

VERY
(Under

POOR
75%)

POOR
(76-100%)

NEAR POOR
(101-150%)

NOT POOR
(Over 150%)

TOTAL

Ufider 6

58.424

1.9

0.9 %

2.3

2.9 %

8.0 %

6 to 17

168,605

5.1

2.4

5.8

9.9

23.2

18 to 64

483,174

12.1

5.9

15.0

33.4

66.4

55 and up

17,555

0.1

0.2

2.0

2.4

rOTAL

727,758

19.2 %

9.3 %

23.2 %

48.3 % 100.0 %

OURCtS:

Estimated based on data from the following sources-

077 ^"!^'^^ f J"'""^ '""^ Education (North Carolina data)

1977 National Medical Care Expenditure Survey .Jk.

1981 North Carolina Citizens Survey (Fall)

1982 North Carolina Citizens Survey (Fall)

1983 Colorado Health Survey

EDUCATION, EMPLOYMENT AND INCOM

IN NORTH CAROLINA,

OULT^ 18 TO 54

BY INSURANCE STATUS

CHARACTERISTIC

SAMPLE SIZE

UNINSURED

501

PRIVATE
COVERAGE

3,999

MEDICAID

343

EDUCATION*

0 to 8 Years

9 to 11

13 to 15

16 and over

EMPLOYMENT STATUS*

Full-time Worker

Part-time Worker

Unemployed

Not Seeking Work

New Job (under 1 year)

FAMILY INCOME

$0 to 9,999

10,000 to 14,999

15,000 to 19,999

20,000 to 29,999

30,000 and over

PUBLIC SOURCES OF INCOME**

Unemployment Compensation

Veterans Payments

Social Security

Workmens' Compensation

Welfare (AFDC or SSI)

At least one of above

North Carolina Citizens Surveys, 1979 to 1983.

All figures shown ire for adults 18 through 64. Percentages Are based on the
average for all years in which a particular question was asked. All percentages
are based on weighted survey responses unless otherwise shown.

on unweighted responses,
ast part of the family's income came from the sources shown,

DEMOGRAPHIC CHARACTERISTICS OF ADULTS 18 TO 64
IN NORTH CAROLINA, BY INSURANCE STA1US

CHARACTERISTIC
SAMPLE SIZE

AGE*

18 to 29

30 to 49

50 to 64

SEX (Percent Female)*

RACE
Whi te
Black

HOUSEHOLD SIZE

1 member

2 members

3 or more

COMMUNITY SIZE
Under 2,500
2,500 to 9,999
10,000 to 49,999
50,000 and over

REGION
Mountain
Piedmont
Coastal Plain
Coast

UNINSURED
501

39 %

6
18
76

NUMBER OF CHILDREN UNDER 18** 1.32

17
42
29

PRIVATE
COVERAGE

3,999

27 %

78
20

6
25

1.01

45
49

10
21
70

1.74

14
47
29
10

North Carolina Citizens Surveys, 1979 to 1983.

All figures shown are for adults 18 through 64, Percentages are based on the
average for all years in which a particular question was asked. All percentages
ire based on weighted survey responses unless otherwise shown.

gures shown are b^scd on unweighted responses.

qures shown dre based on ! ,070 uninsured respondents, 7,097 respondents with
ivate insurance and 477 with Medicaid.

TRENDS IN LACK OF HEALTH INSURANCE COVERAGE AMONG ADULTS IN
NORTH CAROLINA, 1979 to 1984

INSURANCE

STATUS

1981

1982

1983

SAMPLE SIZE

1,267

1,406

1,465

Uninsured

10.6

9.5

9.9

Private Coverage

61.8

63.3

68.1

Medicare

16.8

20.0

14.0

Medicaid

4,9

3.9

3.8

Other*

6.0

3.4

4.3

TOTAL

100.0%

[: North Carolina Citizens Surveys, 1979 to 1983.

[: All figures shown are for adults age 18 and over. Percentages are

based on weighted survey results and may not add to 100 due to
rounding.

icludes CHAMPUS, coverage by health maint^^rfSfc organizations, etc.

\ Y-

Fig. 1

PUBLICLY FUNDED MEDICAL SERVICES

PROGRAMS IN NORTH CAROLINA

WHICH SERVE UNINSURED POOR PERSONS

CATEGORICAL ENTITLEMENTS
VA Health Services
Migrant Health
Refugee Health
Indian Health

PRIMARY CARE CENTERS
Rural Health Centers
Federal Community Health Centers (CHCs)

MATERNAL & CHILD HEALTH

Maternal Health

Fami ly Planning

High Risk Maternity

Perinatal

Del i very Fund

Title XX Sterilizations

State Abortion Fund

Child Health

Immunization

School Health

Dental Health

ADULT HEALTH
Adult Primary Care
Other Adult Health
Cancer Control
Kidney Disease
TB Control
VD Control

GENERAL HEALTH
Health Aid Counties
Home Health
Medical Eye Care
Emergency Medical

DEVELOPMENTAL HEALTH

Medical Vocational Rehabilitation

Genetic Health

Developmental Evaluation Centers

Crippled Children

Lenox Baker Hospital

MENTAL HEALTH

Mental Health Centers

Alcohol Rehabilitation Centers

State Mental Hospitals

Fig. 3

NG OF PUBLICLY FUNDED MEDICAL SERVICES PROGRAMS
ON UNINSURED POOR PERSONS,
STATE FY1984

ESTIMATED DISTRIBUTION OF EXPENDITURES

TOTAL FY84 Persons Below Poverty Level Persons TOTAL PUBLIC

EXPENDITURES Above EXPENDITURES Of.

(thousands) Uninsured Medicaid Other Poverty UNINSURED POOR ,

N BASELINE* 3.4 % 4.4 X 11.3 % 80.9 X

AL ENTITLEMENTS $ 141,065.7 7.5 3.5 26.9 62.1 $ 10,557.6

\Ri CENTERS 24,276.6 7.9 7.3 25.3 59.6 1.883.9

I CHILD HEALTH 33,844.6 46.6 * 9.7 24.5 19.2 15,786.6

-TH 8,610.2 24.3 3.1 23.5 49.1 2,094.2

:ALTH 112,486.3 5.2 6.1 17.0 71.7 5,821.6

<TAL HEALTH 34,519.3 29.1 7.6 44.2 19.1 10,057.0

^LTH 198,173.2 12.1 4.9 32.4 50.6 24,026.3

^S $ 552,976.6 12.7 X 5.3 X 27.7 X 54.3 X $ 70,227.2

:ion baseline shows the distribution of the genera! population in North Carolina.

IMA TED PER CAPITA EXPENDITURES
FOR MEDICAL SERVICES TO UNINSURED POOR PERSONS
THROUGH PUBLIC MEDICAL CARE PROGRAMS
NORTH CAROLINA, FY84

ROGRAM CATEGORY

TOTAL FY84

EXPENDITURES

(thousands)

$ 10,588.6

PERCENT
DISTRIBUTION

15.1 X

EKPENOITURES PER
CAPITA UNINSURED
POOR PERSON

ategorical Entitlements

ridiary Care Clinics

1,883.9

2.7

aternal & Child Health

15,786.6

22.4

Jult Health

2,094.2

3.0

...iiral Health

5,821.6

8.3

'velopmental Health

10,057.0

14.3

ntal Health

24,026.3

34.2

116

TAL

$ 70,227.2

100.0

33ft

TE:

Expenditures per capita were obtained by dividing total expenditures on
on an'^erardV^ ''' ''''^'''' ''' ^''' ^°°^ ^— ^^" are'ui^^LVed

ESTIMATED EXPEN^TOES W PUBLICLY FUNDED MEDICAL CARL FUR
UNINSURED POOR PERSONS, BY REVENUE SOURCE
STATE F-Y1984

PROGRAM

CATEGORICAL ENTITLEMENTS
PRIMARY CARE CENTERS
MATERNAL & CHILD HEALTH
ADULT HEALTH
GENERAL HEALTH
DEVELOPMENTAL HEALTH
MENTAL HEALTH

ALL PROGRAMS

UNINSURED
POOR PER-
CENT OF
PROGRAM
OUTLAYS

TOTAL FY84
OUTLAYS ON
UNINSURED
POOR

SOURCE

OF REVENUE

Federal

State

Local

7.5 %

$ 10.588.6

97 %

3 %

0 %

7.9

1,883.9

46.6

15,786.6

24.3

2,094.2

5.2

5,821.6

29.1

10,057.0

24.7

i 24,026.3

12.7 %

$ 70,227.2

38 %

50 %

12 %

Deductions from Gross Revenues
North Carolina Community Hospitals (1962)

Ownership Cont'

-actual

Bad Debt

Charity

Other

Total*

Type Adju<

>tinents

Public (28)

$( thousands)

44.616

27,092

19,337

1.265

91.940

X Of Deductions

50.2

42.4

6.8

1.2

100

% of Gross Revenues

9.6

6.9

1.3

0.2

17.8

Hon-Proflt (37)

S( thousands)

153.495

101.094

23,308

21.195

299.090

% of Deductions

56.7

32.6

7.7

3.1

100

% of Gross Revenue-;

10.2

5.8

1.3

0.5

17.6

for-profit (15)

S( thousands)

15.896

3.645

397

1.076

21,014

t of Deductions^

65.6

24.0

2.2

6.2

100

1 of Gross Revenues

9.5

2.6

0.3

0.7

13.0

Total (130)

S( thousands)

214.006

131,831

43,042

23.536

412.044

% of Deductions''

56.3

33.7

6.9

3.3

100

% of Gross Revenues

10.0

5.7

1.2

0.4

17.3

Sum of columns may differ from Total due to reporting error.
Unweighted mean across hospitals.

tein^ NefTTeMiiiW and Costs, by Patf«nt Category
North Carolina Community Hospitals (1982)

Ownership

Medicare

Medicaid

Blue Cross

Commercial

Self Pay

Total*

Public (28)

Costs. (JOOO)

* c

1 SI. 596

44,465

67.926

108.080

46,242

449,941

39.1

10.8

15.6

20.0

10.8

100

Surplus jL-)*^
t Relwb.

2,430

(2,364)

7,696

7,852

(12.315)

1,197

96.2

95.6

112.2

105.1

82.8

98.9

Non-ProfIt (87)

Costs.(JOOO)

509,279

98.832

249.156

348,507

127.142

1.400.000

40.6

7.6

16.0

23.4

9.3

100

Surplus L-r
% Reimb.

(11,074)

(5.747)

31.423

54,152

(25,090)

50,778

96.7

92.8

112.6

113.7

60.4

101.7

For-profit (15)

Costs.(JOOO)

* r

49,120

7.299

15,819

35,817

9,399

123,058

39.8

7.3

11.3

29.1

8.8

100

Surplus L-r
t Reimb.

(4.260)

(1.105)

295

2,186

(877)

(399)

91.5

86.1

101.5

103.6

89.4

100.0

Total (130)

Costs.(JOOO)
^ c

709,995

150,595

332.902

492.404

182,782

1,972,567

40.2

8.2

15.4

23.3

9.6

100

Surplus i-)
I Re1«b.°

(12.905)

(9.216)

39.414

64,189

(38.282)

50,576

96.0

92.6

111.4

110.7

82.0

100.9

Columns do not sum to Total, due to Other patients, not reported hert.
Unweighted mean.
^Net Patient Revenue-(Total Expenses-Other Operating Revenue).

Net Patient Revenue/(Total Expenses-Other Operating Revenue), unweighted mean.

Table 3.5 DI

m-JmO BAD DEBT. BY OWNERSHIP. SIZE AND TEACHING STATUS:
5RTH CAROLINA COMMUNITY HOSPITALS

e of
pita]

Number of
Hospitals

ership Beds

lie < 100 14

100-300 8

> 300 6
-profit < 100 29

100-300 40

> 300 18
•profit < 100 7

100-300 8

il 130

rship Teaching

Status

ic no teaching 24

minor teaching 2

major teaching 2

profit no teaching 77

minor teaching 6

major teaching 4

profit no teaching 14

minor teaching 1

1 130

Revenue Deductions (Percent)
Beds Charity Bad Debt Contractual
(^^ Adjustments

Total

3.8

6.3

13.7

7.5

27.3

35.0

1.9

4.6

100.0

0.9

3.4

43.0

3.2

15.8

32.7

0.2

0.8

100.0

3.6

5.6

11.7

5.6

25.6

44.9

0.8

2.2

100.0

13.4

4.3

11.1

4.4

3.0

5.9

40.0

6.9

48.2

24.5

41.6

10.9

17.8

13.9

10.7

9.5

20.6

6.4

1.0

3.0

0.1

0.0

100.0

3.1

2.9

5.7

5.0

12.0

14.8

5.6

5.1

28.5

25.1

37.1

41.6

1.4

1.1

6.6

4.4

100.0

9.8

9.1

3.4

3.1

7.5

10.6

48.3

41.6

12.7

13.3

10.3

17.0

8.0

5.4

0.0

100.0

Table 3.6

.T>

DISTRIBUTION «F A.^huo MEDICAID PATIt^TS. er 0«««SHIP

ON '9FjLf<

morJ^.^^^ TEACHINg'sTATUS
NORTH CAROLINA COMMUNITY HOSPITALS

Type of
Hospital

Ownership Beds
Pub 1 i c <~nj0

100-300
> 300

Non-profit < 100

100-300
> 300

For-profit < 100

100-300
Jtal

Number of T^tiT SeTmr"

-ll°i£iiill__l^i£enses__Ex£en^

14
8
6
29
40
18
7
8
130

Ownership Teaching

— ,^ Status

•Jb'ic no~tiiarrng 24

minor teaching 2

major teaching 2

on-profit no teaching 77

minor teaching 6

major teaching 4

"■-profit no teaching 14

minor teaching 1

''' 130

2.7
4.5
15.7
5.0
22.1
43.9
1.4
4.9
100.0

2.6

5.5
17.2
4.7
22.1
42.7
1.6
3.6
100.0

Self Pay
Deficit

1.6
6.2
23.3
3.4
25.1
36.9
0.2
3.2
100.0

Medicaid
Expenses

3.2
3.4
23.0
4.9
19.3
41.4
1.5
3.3
100.0

Medicaid
Deficit

3.3
4.3
17.9
5.4
19.6
40.3
2.4
6.9
100.0

9.0

10.7

8.2

9.5

14. C

4.0

2.9

3.1

9.8

11.7

22.9

16.9

11.5

39.8

37.6

30.6

31.1

29.8

12.5

14.3

19.2

12.0

13.3

18.7

17.7

15.8

23.0

22.2

6.1

5.0

3.3

4.6

8.7

0.1

0.2

0.5

100.0

i'^^

/\^

Table

3.9 Uncompensated Care c

jue to Private

Patients

rth Carol

ina Commut

lity Hosf

)itals, FY82 ($000)

Public

Non-Prof it

For-Prof it

Total

Charity

19.337

23,308

397

43,042

Bad Debt

27,092

101,094

3,645

131,831

Total Private
Deductions from
Gross Revenues

47,429

124,402

4,042

174,873

Adjusted to ,
Operating Cost

38,783

98.173

3,483

140.439

Offsets

Hil l-Burton^
Obligations

3,733

11,613

202

15,548

Duke Endowment

283

951

1,234

Tax ^

Appropriations 21,766 1,229

23,023

Uncompensated
Care

Total Expenses

% Uncompensated
Care

13,001 84,380
449,941 1,399,568

2.9

6.0

3,253 100,634
123,058 1,972,567

2.6

5.1

X (Total Expenses - Other Operating Revenue) / Gross Revenue

2
Estimated at 10% of Total Obligations

Assumes all reported tax appropriations are for indigent care
Excludes debt service by counties on general obligation bonds and associated
tax expenditures. Excludes appropriations for AHEC.

ESTIMATED PER CAPITA MEDICAL EXPENDITURES
FOR UNINSURED POOR PERSONS,
NORTH CAROLINA, 1984

nPE OF CARE

HOSPITAL CARE
Publicly Funded Programs
Uncompensated Care*

ALL OTHER CARE
Publicly Funded Programs
Uncompensated Care

SOURCES OF

FUNDING

Paid by Patient

Paid By Others

$ 35

S 647

—

152

—

495

$ 123

$ 186

186

—

?7?

TOTAL . $ 158 S 833

* Uncompensated care equals Bad Debts plus Charity, adjusted to costs
and attributable to uninsured poor. Figure shown Is based on actual
1982 costs, and projected to 1984 based on national trends In hosp-
ital Input prices, Intensity of care and utilization rates.

APPENDIX E - HEALTH EDUCATION AND PREVENTIVE
HEALTH CARE - SUBCOMMITTEE MEMBERSHIP

HEALTH EDUCATION AND PREVENTIVE HEALTH CARE
SUBCOMMITTEE

Mrs. Helen Goldston - Chairman
Mrs. Jimmie Butts
Representative Barney Woodard
Mr. Travis Tomlinson, Sr.

APPENDIX F - REPORT OF THE HEALTH EDUCATION AND
PREVENTIVE - HEALTH SUBCOMMITTEE

Sub-Committee on Health Education
Medical Cost Containment Commission

ISSUE: The Health education needs of our State, and how it
is related to health care cost containment.

HISTORY: The Sub-Committee on Health, Education and Prevention
was established to look at issues which covers a
broad scope of health related cost containment. The
)-committee has held two (2) meetings, and at its
Ltial meeting committee members heard from interested
rsons who are involved in health education and planning,
jmmittee members also got an opportunity to express their
views on the issues. They also requested that the FRD
staff have someone from DPI, who is knowledgeable on
health education matters, speak before them at the next
meeting.

J. bro<
^ sub-

^ Cbmr

^ ^ During the last meeting of the committee, committee

^^^^ members heard presentation by FRD and DPI staff on

J^^^ the historical perspective of health education in

^^^ North Carolina. The DPI speaker explained that in

k^ 1977, DPI formulated a long range health education

■ program which included.

A. The employment of a health education coordinator
in each of the local school units;

B. The establishment of a health education
consultant position in DPI;

C. An allocation of monies for the development of a
health education curriculum for grades K-12.

House Bill 540, enacted in 1978, authorized the appropriation
of funds for employing a few health education coordinators,
with the goal of one coordinator per local education agency.
An additional position for a consultant on health education,
the creation of a state-wide health education advisory council,
and the development of a health curriculum (K-9) were also part
of the legislation. In 1979 and 1984 funds were appropriated
for an additional 24 health education coordinators. To date, a
total of 32 coordinator positions have been funded statewide.

A Health Education Curriculum has been developed for
grades K-12 and has been distributed to local school units.
Also, a Health Education Advisory Council has been established.

SUB-COMMITTEE RECOMMENDATIONS:

1- The subcommittee recommends that the Medical Cost
Containment Commission go on record as supporting the
establishment of a health education coordinator
position in all local school units.

2- The subcommittee recommends that the Health Education
Curriculum be included as part of the Basic Education
Plan.

APPENDIX G - HEALTH PLANNING AND CERTIFICATE OF NEED
SUBCOMMITTEE MEMBERSHIP

SUBCOMMITTEE ON HEALTH PLANNING AND CERTIFICATE OF NEED

Mr. Carson Bain - Chairman

Dr. Sandra Greene

Mr. Travis Tomlinson, Sr.

Mr. Jack Willis

Dr. Lawrence Cutchins

Mrs. Jimmie Butts

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